Lieselotte Mahler

Beiträge zur Vermeidung von Zwang in der Akutpsychiatrie

Reduction in coercion in psychiatric treatment requires successful interaction between changes in structural preconditions and therapeutic processes, as well as in individual therapeutic skills and attitudes. The article gives an overview of current approaches and possibilities to minimize the use of coercive interventions and to create non-violent and participative therapeutic settings. These opportunities are discussed against the background of structural and staff resources, social and legal aspects, as well as subjective experience of patients and their right to protection and treatment in phases when freedom of will and self- determination are compromised.

A need for orientation: The WMA statement on natural variations of human sexuality

Abstract An alarming stigmatization and discrimination of homosexual people persists despite the formal depathologization of homosexuality, which occurred through the removal of the diagnosis from the DSM- (1973) and classification from the ICD (1991). The adoption of an expedited Statement on sexual orientation by the majority at the 64th General Assembly of the WMA is therefore an important and overdue measure. The Statement clearly asserts, among other things, that homosexuality is not an illness and therefore requires no cure. It also suggests that direct and indirect discrimination and stigmatization of people due their sexual orientation often leads to psychological and physical illnesses. Furthermore, delegates of the WMA condemned so-called reparative or conversion “therapies”, which strive to induce heterosexual or asexual behavior. These are not only ineffective and unethical, but are strongly associated with serious negative impacts on health. Such a statement from the World Medical Association (WMA) is of particular importance as ambivalence and uncertainty in regards to homosexuality exists even within the medical and therapeutic professions. The latent or manifest attribution of homosexuality as an illness or developmental disorder is still widespread. One possible explanation for this may be the disruption of an open and sustainable discourse on causes, effects and definitions of sexual orientation following the “official depathologization”. Especially those working in the medical and therapeutic contexts should be aware of their special responsibility not to pathologize homosexuality.

Treatment Goal: Recovery

Beyond symptom remission, recovery aims at inclusion and social participation of psychiatric patients irrespective of remaining symptoms and disabilities. It thus places a focus on the patients’ individual resources and creativity, which enable them to participate in society. It also places a strong focus on social exclusion and stigmatization, may they result from passive avoidance or active exclusion of subjects with mental disorders. As such, fighting stigma includes a reflection on the role of psychiatry as a health care institution and its everyday practices. We discuss a person-centred approach in psychiatry that aims at inclusion in the life world and community and discuss several steps that facilitate recovery: reduction of coercive treatment by opening the doors of acute wards, rehabilitation via job placement, empowerment in advocacy groups as well as in the supervision of public health policy, hospital settings and treatment, and direct participation of experienced uses in therapeutic teams. With increasing globalization, we also emphasize the necessary intercultural openness of mental health care institutions and the participation of migrants both in devising health care settings as well in therapeutic teams.